Surgical Treatment for Mesh Infection after Prosthetic Patch Repair of Ventral Hernia_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIU Feide , LI Jiye , YAO Sheng , WANG Shibin , ZHU Yingmei , PEI Lijuan , SHI Xianjie.

Department of General Surgery, The First Affiliated Hospital, General Hospital of PLA, Beijing 100048, China;

Corresponding author：

LIU Feide, Email: feide301@yahoo.com.cn

Keywords：

Abdominal wall defect; Abdominal wall hernia; Prosthetic patch; Mesh infection; Surgical treatment

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ObjectiveTo summarize the method and experience in surgical treatment for mesh infection after prosthetic patch repair of ventral hernia. MethodsThe clinical data of 16 patients with mesh infection after ventral hernia repair accepted surgical treatment in our department from June 2007 to May 2010 were analyzed retrospectively. There were 10 males and 6 females, the age range from 24 to 73 years with an average 45.2 years. The patients with mesh infection included 11 cases of infection after incisional hernia repair, 4 cases of infection after abdominal wall defects repair caused by abdominal wall tumor resection, 1 mesh infection combine with urinary fistula caused by parastomal hernia of ileal neobladder repaired by using prosthetic patch. Clinical manifestation included mesh exposion, abscess, chronic sinus, and enterocutaneous fistula. All patients accepted local treatment of change dressing by primary operative surgeon, but the wounds didn’t heal about 3 to 24 months. Then the patients performed radical removal of infected mesh and abdominal wall reconstruction. ResultsAll patients accepted affected mesh removal successfully. Five patients performed abdominal wall reconstruction by using components separation technique. Four cases accepted abdominal wall repair by using polypropylene mesh. Five patients performed abdominal wall repair by using human acelluar dermal matrix. One case accepted change dressing and vacuum aspiration on the infected wound surface without reconstruction. And one case closed the wound immediately after infected mesh removal. The postoperative hospitalization time was 9 to 25 d (average 14 d). Thirteen patients recovered with primary wound healing. The other 3 cases recovered with second healing by local change dressing. All patients were followed up from 6 to 34 months (average 22 months), no abdominal wall hernia recurrence occurred. ConclusionsIt is very difficult to deal with mesh infection after prosthetic patch repair of abdominal wall hernia or defect. The surgical treatment should be done according to specific condition of each individual so as to acquire satisfied results.

Citation： LIU Feide,LI Jiye,YAO Sheng,WANG Shibin,ZHU Yingmei,PEI Lijuan,SHI Xianjie.. Surgical Treatment for Mesh Infection after Prosthetic Patch Repair of Ventral Hernia. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(12): 1292-1295. doi: Copy

1.	Luijendijk RW, Hop WC, van den Tol MP, et al. A comparison of suture repair with mesh repair for incisional hernia [J]. N Engl J Med, 2000, 343(6): 392398.
2.	Leber GE, Garb JL, Alexander AI, et al. Longterm complications associated with prosthetic repair of incisional hernias [J]. Arch Surg, 1998, 133(4): 378382.
3.	White TJ, Santos MC, Thompson JS. Factors affecting wound complications in repair of ventral hernias [J]. Am Surg, 1998, 64(3): 276280.
4.	Junge K, Rosch R, Klinge U, et al. Gentamicin supplementation of polyvinylidenfluoride mesh materials for infection prophylaxis [J]. Biomaterials, 2005, 26(7): 787793.
5.	Yerdel MA, Akin EB, Dolalan S, et al. Effect of singledose prophylactic ampicillin and sulbactam on wound infection after tensionfree inguinal hernia repair with polypropylene mesh: the randomized, doubleblind,prospective trial [J]. Ann Surg, 2001, 233(1): 2633.
6.	Park A, Birch DW, Lovrics P. Laparoscopic and open incisional hernia repair: a comparison study [J]. Surgery, 1998, 124(4): 816821.
7.	Ríos A, Rodríguez JM, Munitiz V, et al. Antibiotic prophylaxis in incisional hernia repair using a prosthesis [J]. Hernia, 2001, 5(3): 148152.
8.	Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominalwall defects: an anatomic and clinical study [J]. Plast Reconstr Surg, 1990, 86(3): 519526.
9.	Saulis AS, Dumanian GA. Periumbilical rectus abdominis perforator preservation significantly reduces superficial wound complications in “separation of parts” hernia repairs [J]. Plast Reconstr Surg, 2002, 109(7): 22752280.
10.	Fabian TC, Croce MA, Pritchard FE, et al. Planned ventral hernia. Staged management for acute abdominal wall defects [J]. Ann Surg, 1994, 219(6): 643650.
11.	Dibello JN, Moore JH. Sliding myofascial flap of the rectus abdominus muscles for the closure of recurrent ventral hernias [J]. Plast Reconstr Surg, 1996, 98(3): 464469.
12.	Lucas CE, Ledgerwood AM. Autologous closure of giant abdominal wall defects [J]. Am Surg, 1998, 64(7): 607610.
13.	Girotto JA, Ko MJ, Redett R, et al. Closure of chronic abdominal wall defects: a longterm evaluation of the components separation method [J]. Ann Plast Surg, 1999, 42(4): 385394.
14.	Mathes SJ, Steinwald PM, Foster RD, et al. Complex abdominal wallreconstruction: a comparison of flap and mesh closure [J]. Ann Surg, 2000, 232(4): 586596.
15.	Dayton MT, Buchele BA, Shirazi SS, et al. Use of an absorbable mesh to repair contaminated abdominalwall defects [J]. Arch Surg, 1986, 121(8): 954960.
16.	Silverman RP, Li EN, Holton LH, et al. Ventral hernia repair using allogenic acellular dermal matrix in a swine model [J]. Hernia, 2004, 8(4): 336342.
17.	Sclafani AP, McCormick SA, Cocker R. Biophysical and microscopic analysis of homologous dermal and fascial materials for facial aesthetic and reconstructive uses [J]. Arch Facial Plast Surg, 2002, 4(3): 164171.
18.	An G, Walter RJ, Nagy K. Closure of abdominal wall defects using acellular dermal matrix [J]. J Trauma, 2004, 56(6): 12661275.
19.	Menon NG, Rodriguez ED, Byrnes CK, et al. Revascularization of human acellular dermis in fullthickness abdominal wall reconstruction in the rabbit model [J]. Ann Plast Surg, 2003, 50(5): 523527.
20.	Sclafani AP, Romo T 3rd, Jacono AA, et al. Evaluation of acellular dermal graft (alloderm) sheet for soft tissue augmentation: a 1year followup of clinical observations and histological findings [J]. Arch Facial Plast Surg, 2001, 3(2): 101103.

1. Luijendijk RW, Hop WC, van den Tol MP, et al. A comparison of suture repair with mesh repair for incisional hernia [J]. N Engl J Med, 2000, 343(6): 392398.
2. Leber GE, Garb JL, Alexander AI, et al. Longterm complications associated with prosthetic repair of incisional hernias [J]. Arch Surg, 1998, 133(4): 378382.
3. White TJ, Santos MC, Thompson JS. Factors affecting wound complications in repair of ventral hernias [J]. Am Surg, 1998, 64(3): 276280.
4. Junge K, Rosch R, Klinge U, et al. Gentamicin supplementation of polyvinylidenfluoride mesh materials for infection prophylaxis [J]. Biomaterials, 2005, 26(7): 787793.
5. Yerdel MA, Akin EB, Dolalan S, et al. Effect of singledose prophylactic ampicillin and sulbactam on wound infection after tensionfree inguinal hernia repair with polypropylene mesh: the randomized, doubleblind,prospective trial [J]. Ann Surg, 2001, 233(1): 2633.
6. Park A, Birch DW, Lovrics P. Laparoscopic and open incisional hernia repair: a comparison study [J]. Surgery, 1998, 124(4): 816821.
7. Ríos A, Rodríguez JM, Munitiz V, et al. Antibiotic prophylaxis in incisional hernia repair using a prosthesis [J]. Hernia, 2001, 5(3): 148152.
8. Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominalwall defects: an anatomic and clinical study [J]. Plast Reconstr Surg, 1990, 86(3): 519526.
9. Saulis AS, Dumanian GA. Periumbilical rectus abdominis perforator preservation significantly reduces superficial wound complications in “separation of parts” hernia repairs [J]. Plast Reconstr Surg, 2002, 109(7): 22752280.
10. Fabian TC, Croce MA, Pritchard FE, et al. Planned ventral hernia. Staged management for acute abdominal wall defects [J]. Ann Surg, 1994, 219(6): 643650.
11. Dibello JN, Moore JH. Sliding myofascial flap of the rectus abdominus muscles for the closure of recurrent ventral hernias [J]. Plast Reconstr Surg, 1996, 98(3): 464469.
12. Lucas CE, Ledgerwood AM. Autologous closure of giant abdominal wall defects [J]. Am Surg, 1998, 64(7): 607610.
13. Girotto JA, Ko MJ, Redett R, et al. Closure of chronic abdominal wall defects: a longterm evaluation of the components separation method [J]. Ann Plast Surg, 1999, 42(4): 385394.
14. Mathes SJ, Steinwald PM, Foster RD, et al. Complex abdominal wallreconstruction: a comparison of flap and mesh closure [J]. Ann Surg, 2000, 232(4): 586596.
15. Dayton MT, Buchele BA, Shirazi SS, et al. Use of an absorbable mesh to repair contaminated abdominalwall defects [J]. Arch Surg, 1986, 121(8): 954960.
16. Silverman RP, Li EN, Holton LH, et al. Ventral hernia repair using allogenic acellular dermal matrix in a swine model [J]. Hernia, 2004, 8(4): 336342.
17. Sclafani AP, McCormick SA, Cocker R. Biophysical and microscopic analysis of homologous dermal and fascial materials for facial aesthetic and reconstructive uses [J]. Arch Facial Plast Surg, 2002, 4(3): 164171.
18. An G, Walter RJ, Nagy K. Closure of abdominal wall defects using acellular dermal matrix [J]. J Trauma, 2004, 56(6): 12661275.
19. Menon NG, Rodriguez ED, Byrnes CK, et al. Revascularization of human acellular dermis in fullthickness abdominal wall reconstruction in the rabbit model [J]. Ann Plast Surg, 2003, 50(5): 523527.
20. Sclafani AP, Romo T 3rd, Jacono AA, et al. Evaluation of acellular dermal graft (alloderm) sheet for soft tissue augmentation: a 1year followup of clinical observations and histological findings [J]. Arch Facial Plast Surg, 2001, 3(2): 101103.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Surgical Treatment for Mesh Infection after Prosthetic Patch Repair of Ventral Hernia

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